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Why is it that, after all the initial optimism, so little progress has been made regarding the role of pharmacy technicians? And what might happen in the future? This article, the first in a new series, investigates

It is over three years since it became mandatory for pharmacy technicians to register with the GPhC. It is over a decade (May 2003) since the Royal Pharmaceutical Society announced that it had received confirmation from Government ministers that it could proceed with the regulation of pharmacy technicians.

Mandatory registration of pharmacy technicians was to be introduced in January 2007, but the fundamental shake-up of the regulatory environment, which saw the RPSGB lose its regulatory role, caused the timetable to slip by four years. Registration for pharmacy technicians eventually became mandatory in July 2011.

Given the years leading up to it, and the decade that has passed since that ‘green light’ in 2003, you might think there has been sufficient time to consider what technician registration might mean for the pharmacy workforce.

In the hospital sector technicians are well integrated into the pharmacy team, but in community, little seems to have changed for pharmacy technicians. The changes that have occurred, such as the wider employment of accuracy checking technicians, have been evolutionary, driven by contractual and economic considerations rather than recognition of technicians as registered professionals.

Some might argue that technicians have been losing ground, rather than taking on a higher profile role. The list of activities that might currently be undertaken by a community pharmacy technician differs little from those that a dispensing assistant is expected to perform. This has led some employers to question the need to train or employ technicians: dispensing assistants can do the job, and at a lower salary, so what benefit does a pharmacy technician bring?

Joy Wingfield, honorary professor of law and ethics at the University of Nottingham, points out that many larger multiples have embraced the technician role. They may be taking the long view, anticipating that when the Department of Health’s rebalancing board eventually re-interprets supervision requirements, technicians could have a greater role to play, she says.

Since it takes a minimum of two years to train a technician, filling vacancies for such a role could be difficult in the shortto medium-term if the training pipeline has been wound down.

Reluctance to delegate

Putting the training pipeline and economic issues to one side for the moment, there are other factors holding back a more rapid development of the technician role in community pharmacy. Many of these revolve around pharmacists’ reluctance to delegate in the dispensary, although it is not difficult to see why this is the case.

Some might argue that technicians have been losing ground, rather than taking on a higher profile role

For decades pharmacists have had it drummed into them that they were personally responsible for their professional activities. The responsible pharmacist regulations now place the burden of accountability squarely on the front-line pharmacist and most are aware that there is a possibility of criminal prosecution under Section 64 of the Medicines Act following an unintentional dispensing error. The ‘delegation gene’ is not in a pharmacist’s DNA.

Then there is lack of clarity about what technicians in community pharmacy could or should be expected to take responsibility for. The Pharmacy Order 2010 makes no differentiation between pharmacists and technicians when it comes to what ‘practising’ might entail.

According to section 3 of the Pharmacy Order 2010 “...a person practises as a pharmacist or a pharmacy technician, if, whilst acting in the capacity of or purporting to be a pharmacist or pharmacy technician, that person undertakes any work or gives any advice in relation to the preparation, assembly, dispensing, sale, supply or use of medicines, the science of medicines, the practice of pharmacy or the provision of healthcare.”

RPS president Ash Soni says work is underway to help clarify roles and responsibilities in the community sector. “It would be helpful to have an outline of the activities that technicians might reasonably be expected to undertake,” he says, but adds that it will still be for a pharmacist to determine that the technician is competent to carry out any delegated tasks.

“At the moment it is difficult to look at what extra a technician brings,” he says. As long as funding is based on supply, pharmacists will not be keen to delegate. “What is holding technicians back is the lack of service development within the pharmacy contract. Where service innovation is taking place, then businesses are filling the workforce gap with technicians.”

What happens next regarding technicians could depend on the catchily titled Rebalancing Medicines Legislation and Pharmacy Regulation Programme Board, which has been undertaking a longrunning and major review of pharmacy legislation and regulation, taking in such thorny issues as supervision.

Board members at its May meeting were asked how pharmacy organisations should address the issue and raise awareness of the expertise and role of registered pharmacy technicians among community pharmacists.

The board took the view that “greater clarity was needed on the roles and responsibilities of the members of the pharmacy team in community pharmacies. This should include developing roles for registered pharmacy technicians in new areas, such as working with GPs. Also, an understanding of which areas of the registered pharmacy technicians’ roles within hospitals were transferable to community, and which were not, would be helpful.”

 We need to sit down and work out what can be delegated

“There will be some interesting outcomes in the near future,” predicts Tess Fenn, president of APTUK, who sits on the partners forum, a wider group of stakeholders which the rebalancing board uses to test the waters for its proposals. “A lot will depend on what your service delivery model is, but the APTUK position is very clear. Tasks need to be delegated to competent and trained professionals.

“We need to determine what roles in law are absolutely reserved for pharmacists and what can be delegated. Some pharmacies might not need a pharmacy technician, but for, say, healthy living pharmacies offering a raft of defined services, then you could ask a technician to deliver some of these.”

Ironic

It is ironic that pharmacists, who have been guilty of criticising GPs for failing to use other health professionals to relieve their workload, could be in danger of falling into the same trap if they cannot get to grips with delegation. So what is the answer?

Our situation is no different to that faced by many other professions,says Professor Wingfield. “We need to sit down and work out what can be delegated – it is more about making sure that the right steps are in place,” she says, pointing out that the GMC has detailed guidance on how to delegate and the General Dental Council has had to clarify how dental technicians and hygienists fit into the team.

With delegation on the agenda, pharmacists might want to review how Principle 7 of the GPhC’s Standards of Ethics and Performance can be delivered in practice as it requires pharmacists to take responsibility for their working practices. It says...

“When you work as part of a team, you are accountable for your own decisions and any work you supervise...You must make sure that you delegate tasks only to people who are trained to do them, or who are being trained, and make sure it is clear who is responsible for providing a particular service...”.